Moderate Hypofractionation Effective, Cost-Efficient, and Tolerable in Prostate Cancer

Patients with prostate cancer may be able to undergo shorter courses of radiation therapy without a loss of efficacy.
Patients with prostate cancer may be able to undergo shorter courses of radiation therapy without a loss of efficacy.

Patients with prostate cancer can undergo shorter courses of radiation therapy than current standards. Recent results from 3 multicenter, randomized trials comparing shorter course of radiation therapy with standard course of radiation therapy indicated efficacy and toxicity are similar between the two in patients with prostate cancer.1

Shorter radiation therapy, known as moderate hypofractionation, is 2.5 Gy to 3.0 Gy per fraction, administered daily for 4 to 5 weeks. Standard fractionation is 1.8 Gy to 2.0 Gy per fraction, administered daily for up to 9 weeks.

Moderate hypofractionation is as effective, costs less, and is easier on patients explained Justin Bekelman, MD, an associate professor of Radiation Oncology, Medical Ethics, and Health Policy at the University of Pennsylvania Perelman School of Medicine and Abramson Cancer Center, Philadelphia, Pennsylvania, in a commentary published in the International Journal of Radiation Oncology Biology and Physics.

Approximately one-third of American men with prostate cancer undergo radiation therapy. It is the most common treatment for prostate cancer in men older than 65 years.

In this commentary, the researchers addressed results from 3 trials. The CHHiP, NRG 0415, and PROFIT trials examined a total of 5537 patients with primarily low-risk and intermediate-risk prostate cancer.

Shorter and standard radiation therapy resulted in similar disease control and similar side effects, even when age and race were taken into consideration when stratified for disease severity. Use of hormone therapy did not affect the results.

"The field of radiation oncology should be recognized for technical advances in clinical care that have achieved safe, effective, curative treatment for prostate cancer in fewer weeks," said Bekelman.

However, the researchers cautioned that extreme regimens lasting as few as 5 radiation treatments do not have sufficient support to be advisable, although ongoing clinical trials are assessing the potential benefits.

Reference

1. Bekelman JE, Lee WR. Six questions to ask before we shorten radiation treatments for intact prostate cancer. Int J Radiat Oncol Biol Phys. 2017 Mar. doi: 10.1016/j.ijrobp.2016.11.038 [Epub ahead of print]

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